Unhealthy behaviours and socioeconomic barriers together contribute to 37 per cent of Ontario’s health care costs, at a burden of $134 billion over 10 years. This is among the findings of a new report released today by the Institute for Clinical Evaluative Sciences (ICES), in partnership with The Ottawa Hospital and the University of Ottawa.

However, the researchers also point to some hopeful news: improvements made in reducing Ontarians' unhealthy behaviours have resulted in a 1.9 per cent reduction in attributable health care costs over 10 years, translating to $4.9 billion in savings overall. This reduction in health costs was primarily driven by successful smoking cessation efforts across the province.

The authors say that for every $1 increase in health costs attributed to Ontario’s aging demographic, the province has achieved savings in the range of 20 cents by reducing Ontarian’s unhealthy behaviours such as smoking, unhealthy alcohol consumption, poor diet and physical inactivity.

“Though it may seem modest, a 1.9 per cent reduction in health costs is actually quite substantial compared to other savings we’ve been able to achieve as a province to date,” says Doug Manuel, the study’s lead author who is a senior adjunct scientist at ICES, a senior scientist at The Ottawa Hospital and a professor at the University of Ottawa. “Finding ways to reduce health costs through preventative public health programs will be an important counter weight to the pressures of an aging population.”

Smoking, unhealthy alcohol consumption, poor diet and physical inactivity are known to have a widespread effect on Ontarians' health, but health care planners have to date lacked reliable information about how the cumulative effects of these behaviours drive Ontario’s overall health costs, and how public health efforts can reduce these costs. A report led by Manuel in 2014 determined that 32 per cent of hospital days in Ontario were at least partly attributable to these unhealthy behaviours.

For this new report, the research team built on their earlier findings using data from the Canadian Community Health Survey conducted between 2003 and 2008. They followed individual anonymized respondents over four years, tracking changes in the four unhealthy behaviours over a total span of 10 years. They then calculated the resulting individual-level increase or decrease in direct health care costs, noting such expenses as hospital-based care, drug benefits, OHIP billing, lab tests and home care. They also took into account the individual’s socioeconomic position, including education, family income, housing status and neighbourhood deprivation.

Among the study’s findings:

Overall, Ontarians have improved their unhealthy behaviours, lowering attributable health care costs by 1.9 per cent over the 10-year period. Most of this reduction came from smoking cessation, which alone accounted for 1.7 per cent in these savings.

In total, more than $89.4 billion over the 10-year period could be attributed to health behaviours, or 22 per cent of Ontario’s health care costs.

The impact of lower socioeconomic position accounted for 15 per cent, or $60.7 billon, of Ontario’s health care costs during this period.

Taken together, unhealthy behaviours and socioeconomic position contributed to a burden of $134 billion in health care costs over 10 years, or 37 per cent of Ontario’s health care costs.

“Although we continue to see significant health burdens created by unhealthy behaviours and social inequity, the findings show a silver lining, because these drivers of poor health are within our power as a province to fix,” comments Pegeen Walsh, executive director of the Ontario Public Health Association (OPHA), the knowledge user of this study which was funded through the Applied Health Research Question (AHRQ) initiative of the Ontario Ministry of Health and Long-Term Care. “This report helps us to better map the road ahead and focus our efforts on measures that can improve health for all, reduce inequities and promote a sustainable health system.”

The researchers point to successful reductions in Ontario’s smoking rate, which accounted for 1.7 per cent of the 1.9 per cent reduction in health costs over 10 years. Notes Manuel, “These cost savings were driven by the success of the Smoke-Free Ontario program, demonstrating that comprehensive prevention strategies can and do work to reduce Ontario’s health burden. While previous reports have pointed to what drives up health costs, our study illustrates the effect of the single largest health cost reduction we’ve been able to achieve as a province, and how we can learn from this success to plan other programs to prevent disease and advance health in Ontario.”

The researchers say this is the first large-scale and detailed study to measure how multiple changes in health behaviours and socioeconomic position work together to drive both increases and decreases in health care use and costs, at the individual and population levels.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: ICESOntario

The Ottawa Hospital is one of Canada’s largest learning and research hospitals with over 1,100 beds, approximately 12,000 staff and an annual budget of over $1.2 billion. Our focus on research and learning helps us develop new and innovative ways to treat patients and improve care. As a multi-campus hospital, affiliated with the University of Ottawa, we deliver specialized care to the Eastern Ontario region, but our techniques and research discoveries are adopted around the world. We engage the community at all levels to support our vision for better patient care. See www.ohri.ca for more information about research at The Ottawa Hospital.